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Opinion: Front-Line Healthcare Workers Deserve Hazard Pay

By Wayne Cascio and Andrew Garman and Rulon Stacey  
   May 05, 2020

We believe that it is sound public policy to include subsidies to organizations that employ healthcare professionals responsible for direct patient contact in the next round of pandemic-related legislation. Those subsidies should compensate healthcare professionals for the added risks they are assuming in order to perform their work.

The U.S. President recently compared the COVID-19 pandemic to a war—and, indeed, reports from the frontlines suggest many parallels. Foremost among these may be the toll on the human psyche from prolonged exposure to danger and death. Stories are emerging of clinicians being ordered to work without adequate personal protective equipment, and watching fellow clinicians fall victim to the virus as they care for others. Moral risks are abundant as well, particularly in situations that challenge healthcare workers’ values and professional training. For example, some must make extraordinarily difficult decisions about who should be prioritized if there are not enough ventilators for everyone who needs one.

Before the COVID response even began, the U.S. was facing an epidemic of burnout among its care providers. Recent national surveys suggest that base rates for burnout were running as high as 35% for nurses and 44% for physicians.  Providers who began this crisis already feeling depleted may be at even greater risk for deterioration to their well-being, and these effects could last far longer than the surge itself. Research on clinicians in China from January and February of this year reported significant numbers experiencing symptoms of anxiety, depression, and insomnia—symptoms consistent with a post-traumatic stress response.

Financially, with elective surgeries canceled and ICUs overwhelmed with COVID-19 patients, hospitals are losing money every day. In fact, the COVID-19 crisis has precipitated the most rapid financial decline in the history of American healthcare. Many health systems have reported decreases in revenue of 40 percent or more in just 10 -14 days. This will lead many health systems with a history of healthy financial performance to suffer their first operating losses in memory in FY 2020. 

These reductions in revenue have caused an immediate reduction in the healthcare workforce across the nation. While “hot-spots” like New York are doing all they can to find extra employees, most of the country has discontinued all elective procedures. This has caused not only the sharp decline in revenue, but also the loss of the most profitable business any health system provides. As a consequence, there are not enough providers and staff in some parts of the country, and in others they are being laid off in preparation for the wave of COVID-19 patients we all hope never comes. In either case, health-system employees are assuming a disproportionate amount of the risk that the country is currently facing.

Related: Hazard Pay for Healthcare: Q&A with Rulon Stacey

Most pay systems compensate employees for the additional risks associated with hazardous working conditions that include, among others, biological hazards such as viruses or bacteria that can cause adverse health effects. Soldiers in combat zones receive combat pay and, in some areas, hardship-duty pay as well. Such risk premiums compensate for hazardous working conditions. In the current coronavirus pandemic, frontline healthcare workers are exposed to biological hazards and compromised immune systems due to physical exhaustion every day.

With the passage of the CARES Act, public policy has changed. Traditionally the U.S. resisted subsidizing employers to keep workers, preferring instead to subsidize the unemployed as they search for work. The CARES Act does provide enhanced unemployment benefits but in addition, provides incentives to small businesses (e.g., forgivable loans) if they do not lay off workers. 

We believe that it is sound public policy to include subsidies to organizations that employ healthcare professionals responsible for direct patient contact in the next round of pandemic-related legislation. Those subsidies should compensate healthcare professionals for the added risks they are assuming in order to perform their work. Doing so will enable employers to avoid layoffs due to financial exigency, provide additional compensation for the added risks these workers must assume during the pandemic, and serve the public good by keeping them employed.

Note: Authors are listed alphabetically. Each contributed equally.



Wayne Cascio 
(Photo courtesy of University of Colorado Denver.)

Wayne F. Cascio is a Distinguished University Professor at the University of Colorado, and he holds the Robert H. Reynolds Chair in Global Leadership at the University of Colorado Denver. He is a former president of the Society for Industrial and Organizational Psychology and has served as a member of the Academy of Management’s Board of Governors. He is a Fellow of the National Academy of Human Resources, the Academy of Management, the American Psychological Association, and the Australian Human Resources Institute. Professor Cascio received the Distinguished Career award from the HR Division of the Academy of Management in 1999; an honorary doctorate from the University of Geneva, Switzerland, in 2004; and the Michael R. Losey Human Resources Research Award from the Society for Human Resource Management in 2010. In 2013, he received the Distinguished Scientific Contributions Award from the Society for Industrial and Organizational Psychology, and in 2016, by a vote of 90 countries, he received the George Petitpas [Lifetime Achievement] Award from the World Federation of People Management Associations.

Currently he serves as a consulting editor of the Journal of International Business Studies (JIBS), and from 2007 to 2014 he served as a senior editor of the Journal of World Business. He has consulted with a wide variety of private- and public-sector organizations on six continents, and periodically he testifies as an expert witness in employment discrimination cases. Professor Cascio is an active researcher, writer, and speaker. He has published more than 200 articles and book chapters, and 33 books, including Managing Human Resources (11th ed., 2019), Investing in People (with John Boudreau and Alexis Fink, 3rd ed., 2019), Applied Psychology in Talent Management (with Herman Aguinis, 8th ed., 2019), and Short Introduction to Strategic Human Resource Management (with John Boudreau, 2012). He has delivered more than 750 presentations to professional and business audiences worldwide.


Andy Garman
(Photo courtesy of Rush University.)

Andy is Professor of Health Systems Management at Rush University, and directs the Rush Center for Health System Leadership.  He also works with the non-profit National Center for Healthcare Leadership (NCHL), as a facilitator of learning and action collaboratives for health systems and graduate programs from across the US. Andy is the author of several dozen peer-reviewed papers and book chapters, as well as four books, including "The future of healthcare: Global trends worth watching" and “Exceptional Leadership: 16 critical competencies for healthcare executives,” which was recently released in its second edition. He received his PsyD in clinical psychology from the College of William & Mary, an MS in human resource development from the Illinois Institute of Technology, and a BS in psychology with a mathematics concentration from Pennsylvania State University.


Rulon Stacey
(Photo courtesy of University of Colorado Denver.)

Rulon Stacey has served as the Director of Programs in Health Administration at the University of Colorado Denver since January 1, 2020.  Dr. Stacey comes to CU Denver after 5 years as a Partner with Guidehouse consulting.  During his distinguished career Dr. Stacey has served as a CEO of several different health systems including Fairview Health System in Minneapolis and the Poudre Valley Health System (PVHS) in Fort Collins, Colorado.  During his time at PVHS Dr. Stacey lead the merger of PVHS with University of Colorado Hospital to form UCHealth and became the organization’s inaugural CEO.  As the CEO Dr. Stacey lead the strategic plan to expand UCHealth to include Memorial Health System in Colorado Springs and several other clinics and hospitals throughout the states of Colorado and Wyoming.  While at PVHS Dr. Stacey lead that organization to be one of the first healthcare companies in the country to receive the nation’s most prestigious quality award, The Malcolm Baldrige National Quality Award.

During his career Dr. Stacey has served as the Chair of the Board of Governors for the American College of Healthcare Executives, was appointed by three different United States Secretaries of Commerce to multiple terms as the Chair of the Board of Overseers of the Malcolm Baldrige National Quality Award, was twice selected by Modern Healthcare Magazine as one of the top 100 most influential people in US Healthcare and is currently the Chair of the CEO Circle of the International Hospital Federation based on Geneva, Switzerland.

As a graduate of CU Denver, Dr. Stacey was also selected in 2000 as the Mulstein Scholar, representing that year’s best Ph.D. dissertation in the Graduate School of Public Affairs.  Dr. Stacey is married to the former Linda Smoot of Orem, Utah and together they are the proud parents of four daughters and six grandchildren.

Editor's note: Care to share your view? HealthLeaders accepts original thought leadership articles from healthcare industry leaders in active executive roles at provider and payer organizations. These may include case studies, research, and guest editorials. We neither accept payment nor offer compensation for contributed content. Send questions and submissions to Erika Randall, content manager,

Wayne Cascio, Andy Garman, and Rulon Stacey coauthored this op-ed article.

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